Aortic Stenosis in Pregnancy

Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

“…The increased cardiac output that occurs during pregnancy adds a volume load to a pressure-loaded left ventricle, which, in addition to the fall in afterload, can lead to an increase in gradient. 200 Pregnancy is well tolerated in asymptomatic patients with mild (mean gradient <25 mm Hg) or moderate (mean gradient, 25-40 mm Hg) AS. Patients with severe AS (mean gradient >40 mm Hg, atrioventricular area <1.0 cm 2 ) may tolerate pregnancy and remain asymptomatic, but careful individualized assessment is needed 173,201,202 because complications occur with increased frequency.…”

Noninvasive cardiac output monitoring during general anesthesia for Cesarean delivery in a patient with severe aortic stenosis

“…12 In pregnancy, the continuity equation for the calculation of AVA is least affected by changes in stroke volume and may best estimate the severity of the stenotic lesion. 8 The transvalvular gradient and jet velocity that are measured during pregnancy may be higher than in the post-pregnancy state. 13,14 Therefore, one could argue that this was not a true case of severe AS.…”

“…Careful review of previous studies where pulmonary artery catheters were used for intermittent CO monitoring suggests a rise in CO in patients with severe AS following both vaginal and Cesarean delivery. 8 Brian et al 7 detailed the hemodynamic changes in a pregnant woman with severe AS (transvalvular gradient 90 mmHg) undergoing Cesarean delivery with lumbar epidural anesthesia using a pulmonary artery catheter. They noted a decrease of 44% in systemic vascular resistance following oxytocin administration, with a subsequent net 21% increase in cardiac index, while HR remained unchanged.…”

“…[1][2][3][4][5][6][7] General anesthesia is advocated for its cardiostable properties. 4 The safety of neuraxial anesthesia continues to be questioned, but recent case reports 3,7 and series 2,8 have documented its successful use in this highrisk patient group.…”

Anesthesia for the parturient with cardiovascular disease

“…24 Provision of labor analgesia with segmental epidural anesthesia remains a controversial issue because these patients may not be able to tolerate the decreases in preload and afterload that may attend epidural analgesia and its associated sympathetic blockade. 19 Easterling et al described a series of four patients with moderate to severe aortic stenosis who were successfully managed with epidural anesthesia without untoward sequelae; adequate time was allowed to carefully titrate the level of block and initiate appropriate compensatory actions to correct hemodynamic alterations associated with the anesthetic agent.…”